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5S SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209) �! P O BOX 2009, STOCKTON, CA 5 Q �/�l 1 J `/ PERMIT SIRES YE OM I (Complete in Tripllicat Application is hereby made to San Joaquin County for a permit to construct and/ application is made in counpliettce with San Joaquin County Ordinance No. 50 and Joaquin County ilublic Health Services. Job Address 20550 Kettleman Lane City Owner's Name GUV, AiiJV Address a (fane Phone 466-9607 Contractor i'arriSYl "iS Address _ K 14,50, 1,t -ktnn__952 License No. 2r�3 Phone TYPE OF WELL/PUMP: NEW WELL Q WELL REPLACEMENT _'7 DESTRUCTION C, out of Service Well Cl PUMP INSTALLATION O SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well C] DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE FOUNDATION _ AGRICULTURE WELL OTHER WELL_ PITS,'SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS i_71 Industrial ❑ Open Bottom ❑ Manteca Die of Well Excavation Dia. of Wei Casing DamesffC/Private 0 Gravel Pack CJ Tracy Type of Casing_ Specifications I Public la Other n Drilla Depth of Grout Seal _ Type of Grout I i Irrigation —_. Approx. Depth I i Eastern Surface Sed{ installed by Repair Work Done U Type of Pump H.P. — State Work Done _ Well Destruction ❑ Well Diamew Scaling Material i Depth Filler Material a Depth TYPE OF SEPTIC W NEW INSTAL REPAIR/ADDITION i I OESTRUCTION 1 I (No septic system permitted 4 public sewer is available within 200 feet.) installation will serve: Residence _XX Commercial` Other Number of living units: I — Number of bedrooms 1 Character of soil to a depth of 3 feet: C:l BSI Water table depth ' SEPTIC TANK XIX TypelMfg ConCret� Capacity 1200 No. Compartments PKG. TREATMENT PLT.❑ Method of Disposal Distance to nearest: Well 20 4 Foundation-' Property Line LEACHING LINE XX No. b Length of tinea _Tl — 5fl' Total iengthlsizec ' 2' ' y FILTER BED ❑ Distance to nearest: 80#Wool Foundation Win' Pfoperty Line 110' SEEPAGE PITS XX Depth25'5 —Size 36" — Number _I SUMPS LI Distance to nearest, Well 140' Foundation 35' _ Property Lina300—' DISPOSAL PONDS Q I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county OrdinanCes, state laws; and rules and regulations of the San Joaquin County Home owrwr or licensed agent's signature certifies the following: "I certify that in the performance of the work for which this permit is issued. I shall not empicy any person in such manner as io become subject to workmen's compensation laws of California." Conirac,of's hiring or sub-contracting signature certifies the foiowing: "I certify that in the performance of the work for which this permit is issued, I snaii employ persona subject to workmen's compensa- tion laws of California," The applicant t call for a wired inspections. Complete drawing on reverse side. Signed - ?' rne; Vise President Deva: -2 93 FOR DEPARTMENT USE ONLY Application Accepter by Date or Grout Inspection by DateFinal Jnapect I VIK / ! �/ Additional Crxnmenu: 7 YOM() t Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 952 FEE INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVEDAY DATE PERM17NO. EH F�t13-2113-214mi teV. � .�. 93-Dl � f iso